Individual provider Active NPI

Nineveh A McIntosh, PA-C

  • Physician Assistant
  • St. Johns, FL
National Provider Identifier
1730430893
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9106841 Issued in FL
Practice address
30 Ardisia Lane
St. Johns, FL 32259
Phone
(904) 287-2794
Fax
(904) 390-7458
NPI assigned
Sep 28, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9106841 FL
Physician Assistant 363A00000X PA9106841 FL Primary

Addresses

Primary practice location

30 Ardisia Lane
St. Johns, FL 32259

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-1032

Other practice location 1

1400 Bishop Estates Rd
Jacksonville, FL 32259-4244
Phone (904) 287-2794

Other names 1

  • Nineveh A Dawson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121212000060 FL Practitioner - Physician Assistant 0941452361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Primary Care IncGroup PAC ID 0648177733, 459 clinicians

Practice addresses (Care Compare)

120 Gateway Cir
Unit 1
Jacksonville, FL 32259-4083
Phone (904) 824-4407

1310 County Rd 210
St Johns, FL 32259
Phone (904) 824-4407

1400 Bishop Estates Rd
Jacksonville, FL 32259-4244
Phone (904) 287-2794

1660 Prudential Dr
Suite 201
Jacksonville, FL 32207-8185
Phone (904) 202-4222

1660 Prudential Dr
Suite 310
Jacksonville, FL 32207-8197
Phone (904) 396-8656

1660 Prudential Dr
Suite 400
Jacksonville, FL 32207-8188
Phone (904) 396-0000

30 Ardisia Lane
St Johns, FL 32259
Phone (904) 287-2794

3563 Phillips Hwy 101
Jacksonville, FL 32207

550 Durbin Pavilion Dr
Suite G101
St Johns, FL 32259-4135
Phone (904) 770-2095

820 Prudential Dr
Suite 304
Jacksonville, FL 32207-8205
Phone (904) 202-3860

820 Prudential Dr
Suite 515
Jacksonville, FL 32207-8207
Phone (904) 396-4886

836 Prudential Dr
Suite 105a
Jacksonville, FL 32207-8300
Phone (904) 202-4325

Hospital & facility affiliations

  • Baptist Home Health Care by Bayada Home health agency, Jacksonville, FL, CCN 107482
  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9106841FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Primary Care Inc Physician Assistant CurrentSince Aug 31, 2020 Accepting new patients
Baptist Primary Care Inc CurrentSince Aug 31, 2020 Accepting new patients

Locations

836 Prudential Dr
Ste 1207
Jacksonville, FL 32207
Phone (904) 396-8656

1400 Bishop Estates Rd
Jacksonville, FL 32259
Phone (904) 287-2794

30 Ardisia Ln
St Johns, FL 32259
Phone (904) 287-2794

Interoperability endpoints

  • Direct secure messaging: nmcintosh22575@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1730430893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 ARDISIA LANE",
            "city": "ST. JOHNS",
            "state": "FL",
            "postal_code": "32259",
            "telephone_number": "904-287-2794",
            "fax_number": "904-390-7458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Bishop Estates Rd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322594244",
            "country_code": "US",
            "telephone_number": "904-287-2794",
            "fax_number": "904-287-5362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCINTOSH",
        "first_name": "NINEVEH",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-28",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106841",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NINEVEH",
            "last_name": "DAWSON",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St. Johns, FL

Sources for this page

Verify at the official NPI Registry.